Bill Amendment: IL SB2697 | 2023-2024 | 103rd General Assembly
NOTE: For additional amemendments please see the Bill Drafting List
Bill Title: INS CD-CANCER-GENETIC TESTING
Status: 2024-05-22 - Added Alternate Chief Co-Sponsor Rep. Marcus C. Evans, Jr. [SB2697 Detail]
Download: Illinois-2023-SB2697-Senate_Amendment_002.html
Bill Title: INS CD-CANCER-GENETIC TESTING
Status: 2024-05-22 - Added Alternate Chief Co-Sponsor Rep. Marcus C. Evans, Jr. [SB2697 Detail]
Download: Illinois-2023-SB2697-Senate_Amendment_002.html
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1 | AMENDMENT TO SENATE BILL 2697 | ||||||
2 | AMENDMENT NO. ______. Amend Senate Bill 2697, AS AMENDED, | ||||||
3 | by replacing everything after the enacting clause with the | ||||||
4 | following:
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5 | "Section 5. The State Employees Group Insurance Act of | ||||||
6 | 1971 is amended by changing Section 6.11 as follows:
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7 | (5 ILCS 375/6.11) | ||||||
8 | Sec. 6.11. Required health benefits; Illinois Insurance | ||||||
9 | Code requirements. The program of health benefits shall | ||||||
10 | provide the post-mastectomy care benefits required to be | ||||||
11 | covered by a policy of accident and health insurance under | ||||||
12 | Section 356t of the Illinois Insurance Code. The program of | ||||||
13 | health benefits shall provide the coverage required under | ||||||
14 | Sections 356g, 356g.5, 356g.5-1, 356m, 356q, 356u, 356u.10, | ||||||
15 | 356w, 356x, 356z.2, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, | ||||||
16 | 356z.10, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.17, |
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1 | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, | ||||||
2 | 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||||||
3 | 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.59, | ||||||
4 | 356z.60, and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, | ||||||
5 | and 356z.70 of the Illinois Insurance Code. The program of | ||||||
6 | health benefits must comply with Sections 155.22a, 155.37, | ||||||
7 | 355b, 356z.19, 370c, and 370c.1 and Article XXXIIB of the | ||||||
8 | Illinois Insurance Code. The program of health benefits shall | ||||||
9 | provide the coverage required under Section 356m of the | ||||||
10 | Illinois Insurance Code and, for the employees of the State | ||||||
11 | Employee Group Insurance Program only, the coverage as also | ||||||
12 | provided in Section 6.11B of this Act. The Department of | ||||||
13 | Insurance shall enforce the requirements of this Section with | ||||||
14 | respect to Sections 370c and 370c.1 of the Illinois Insurance | ||||||
15 | Code; all other requirements of this Section shall be enforced | ||||||
16 | by the Department of Central Management Services. | ||||||
17 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
18 | any, is conditioned on the rules being adopted in accordance | ||||||
19 | with all provisions of the Illinois Administrative Procedure | ||||||
20 | Act and all rules and procedures of the Joint Committee on | ||||||
21 | Administrative Rules; any purported rule not so adopted, for | ||||||
22 | whatever reason, is unauthorized. | ||||||
23 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
24 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
25 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-768, | ||||||
26 | eff. 1-1-24; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; |
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1 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
2 | 1-1-23; 102-1117, eff. 1-13-23; 103-8, eff. 1-1-24; 103-84, | ||||||
3 | eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, eff. 1-1-24; | ||||||
4 | 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; 103-551, eff. | ||||||
5 | 8-11-23; revised 8-29-23.)
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6 | Section 10. The Counties Code is amended by changing | ||||||
7 | Section 5-1069.3 as follows:
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8 | (55 ILCS 5/5-1069.3) | ||||||
9 | Sec. 5-1069.3. Required health benefits. If a county, | ||||||
10 | including a home rule county, is a self-insurer for purposes | ||||||
11 | of providing health insurance coverage for its employees, the | ||||||
12 | coverage shall include coverage for the post-mastectomy care | ||||||
13 | benefits required to be covered by a policy of accident and | ||||||
14 | health insurance under Section 356t and the coverage required | ||||||
15 | under Sections 356g, 356g.5, 356g.5-1, 356q, 356u, 356u.10, | ||||||
16 | 356w, 356x, 356z.4, 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, | ||||||
17 | 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, | ||||||
18 | 356z.26, 356z.29, 356z.30a, 356z.32, 356z.33, 356z.36, | ||||||
19 | 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, | ||||||
20 | 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, and | ||||||
21 | 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and 356z.70 | ||||||
22 | of the Illinois Insurance Code. The coverage shall comply with | ||||||
23 | Sections 155.22a, 355b, 356z.19, and 370c of the Illinois | ||||||
24 | Insurance Code. The Department of Insurance shall enforce the |
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1 | requirements of this Section. The requirement that health | ||||||
2 | benefits be covered as provided in this Section is an | ||||||
3 | exclusive power and function of the State and is a denial and | ||||||
4 | limitation under Article VII, Section 6, subsection (h) of the | ||||||
5 | Illinois Constitution. A home rule county to which this | ||||||
6 | Section applies must comply with every provision of this | ||||||
7 | Section. | ||||||
8 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
9 | any, is conditioned on the rules being adopted in accordance | ||||||
10 | with all provisions of the Illinois Administrative Procedure | ||||||
11 | Act and all rules and procedures of the Joint Committee on | ||||||
12 | Administrative Rules; any purported rule not so adopted, for | ||||||
13 | whatever reason, is unauthorized. | ||||||
14 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
15 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
16 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||||||
17 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
18 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
19 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
20 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
21 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
22 | 8-29-23.)
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23 | Section 15. The Illinois Municipal Code is amended by | ||||||
24 | changing Section 10-4-2.3 as follows:
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1 | (65 ILCS 5/10-4-2.3) | ||||||
2 | Sec. 10-4-2.3. Required health benefits. If a | ||||||
3 | municipality, including a home rule municipality, is a | ||||||
4 | self-insurer for purposes of providing health insurance | ||||||
5 | coverage for its employees, the coverage shall include | ||||||
6 | coverage for the post-mastectomy care benefits required to be | ||||||
7 | covered by a policy of accident and health insurance under | ||||||
8 | Section 356t and the coverage required under Sections 356g, | ||||||
9 | 356g.5, 356g.5-1, 356q, 356u, 356u.10, 356w, 356x, 356z.4, | ||||||
10 | 356z.4a, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
11 | 356z.13, 356z.14, 356z.15, 356z.22, 356z.25, 356z.26, 356z.29, | ||||||
12 | 356z.30a, 356z.32, 356z.33, 356z.36, 356z.40, 356z.41, | ||||||
13 | 356z.45, 356z.46, 356z.47, 356z.48, 356z.51, 356z.53, 356z.54, | ||||||
14 | 356z.56, 356z.57, 356z.59, 356z.60, and 356z.61, and 356z.62 , | ||||||
15 | 356z.64, 356z.67, 356z.68, and 356z.70 of the Illinois | ||||||
16 | Insurance Code. The coverage shall comply with Sections | ||||||
17 | 155.22a, 355b, 356z.19, and 370c of the Illinois Insurance | ||||||
18 | Code. The Department of Insurance shall enforce the | ||||||
19 | requirements of this Section. The requirement that health | ||||||
20 | benefits be covered as provided in this is an exclusive power | ||||||
21 | and function of the State and is a denial and limitation under | ||||||
22 | Article VII, Section 6, subsection (h) of the Illinois | ||||||
23 | Constitution. A home rule municipality to which this Section | ||||||
24 | applies must comply with every provision of this Section. | ||||||
25 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
26 | any, is conditioned on the rules being adopted in accordance |
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1 | with all provisions of the Illinois Administrative Procedure | ||||||
2 | Act and all rules and procedures of the Joint Committee on | ||||||
3 | Administrative Rules; any purported rule not so adopted, for | ||||||
4 | whatever reason, is unauthorized. | ||||||
5 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
6 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
7 | 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. 10-8-21; 102-731, | ||||||
8 | eff. 1-1-23; 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; | ||||||
9 | 102-816, eff. 1-1-23; 102-860, eff. 1-1-23; 102-1093, eff. | ||||||
10 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
11 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
12 | 103-535, eff. 8-11-23; 103-551, eff. 8-11-23; revised | ||||||
13 | 8-29-23.)
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14 | Section 20. The School Code is amended by changing Section | ||||||
15 | 10-22.3f as follows:
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16 | (105 ILCS 5/10-22.3f) | ||||||
17 | Sec. 10-22.3f. Required health benefits. Insurance | ||||||
18 | protection and benefits for employees shall provide the | ||||||
19 | post-mastectomy care benefits required to be covered by a | ||||||
20 | policy of accident and health insurance under Section 356t and | ||||||
21 | the coverage required under Sections 356g, 356g.5, 356g.5-1, | ||||||
22 | 356q, 356u, 356u.10, 356w, 356x, 356z.4, 356z.4a, 356z.6, | ||||||
23 | 356z.8, 356z.9, 356z.11, 356z.12, 356z.13, 356z.14, 356z.15, | ||||||
24 | 356z.22, 356z.25, 356z.26, 356z.29, 356z.30a, 356z.32, |
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1 | 356z.33, 356z.36, 356z.40, 356z.41, 356z.45, 356z.46, 356z.47, | ||||||
2 | 356z.51, 356z.53, 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, | ||||||
3 | and 356z.61, and 356z.62 , 356z.64, 356z.67, 356z.68, and | ||||||
4 | 356z.70 of the Illinois Insurance Code. Insurance policies | ||||||
5 | shall comply with Section 356z.19 of the Illinois Insurance | ||||||
6 | Code. The coverage shall comply with Sections 155.22a, 355b, | ||||||
7 | and 370c of the Illinois Insurance Code. The Department of | ||||||
8 | Insurance shall enforce the requirements of this Section. | ||||||
9 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
10 | any, is conditioned on the rules being adopted in accordance | ||||||
11 | with all provisions of the Illinois Administrative Procedure | ||||||
12 | Act and all rules and procedures of the Joint Committee on | ||||||
13 | Administrative Rules; any purported rule not so adopted, for | ||||||
14 | whatever reason, is unauthorized. | ||||||
15 | (Source: P.A. 102-30, eff. 1-1-22; 102-103, eff. 1-1-22; | ||||||
16 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-642, eff. | ||||||
17 | 1-1-22; 102-665, eff. 10-8-21; 102-731, eff. 1-1-23; 102-804, | ||||||
18 | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||||||
19 | 102-860, eff. 1-1-23; 102-1093, eff. 1-1-23; 102-1117, eff. | ||||||
20 | 1-13-23; 103-84, eff. 1-1-24; 103-91, eff. 1-1-24; 103-420, | ||||||
21 | eff. 1-1-24; 103-445, eff. 1-1-24; 103-535, eff. 8-11-23; | ||||||
22 | 103-551, eff. 8-11-23; revised 8-29-23.)
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23 | Section 25. The Illinois Insurance Code is amended by | ||||||
24 | adding Section 356u.10 as follows:
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1 | (215 ILCS 5/356u.10 new) | ||||||
2 | Sec. 356u.10. Genetic testing and evidence-based | ||||||
3 | screenings for an inherited gene mutation. | ||||||
4 | (a) In this Section, "genetic testing for an inherited | ||||||
5 | mutation" means germline multi-gene testing for an inherited | ||||||
6 | mutation associated with an increased risk of cancer in | ||||||
7 | accordance with evidence-based, clinical practice guidelines. | ||||||
8 | (b) A group policy of accident and health insurance or | ||||||
9 | managed care plan that is amended, delivered, issued, or | ||||||
10 | renewed after January 1, 2026 shall provide coverage for | ||||||
11 | clinical genetic testing for an inherited gene mutation for | ||||||
12 | individuals with a personal or family history of cancer, as | ||||||
13 | recommended by a health care professional in accordance with | ||||||
14 | current evidence-based clinical practice guidelines, | ||||||
15 | including, but not limited to, the current version of the | ||||||
16 | National Comprehensive Cancer Network clinical practice | ||||||
17 | guidelines. The coverage shall limit the total amount that a | ||||||
18 | covered person is required to pay for a clinical genetic test | ||||||
19 | under this subsection to an amount not to exceed $50, except | ||||||
20 | for services for which cost sharing is prohibited under 42 | ||||||
21 | U.S.C. 300gg-13. This subsection (b) shall not apply to | ||||||
22 | coverage of genetic testing to the extent such coverage would | ||||||
23 | disqualify a high-deductible health plan from eligibility for | ||||||
24 | a health savings account pursuant to Section 223 of the | ||||||
25 | Internal Revenue Code. | ||||||
26 | (c) For individuals with a genetic test that is positive |
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1 | for an inherited mutation associated with an increased risk of | ||||||
2 | cancer, coverage required under this Section shall include any | ||||||
3 | evidence-based screenings, as recommended by a health care | ||||||
4 | professional in accordance with current evidence-based | ||||||
5 | clinical practice guidelines, to the extent that the | ||||||
6 | management recommendation is not already covered by the | ||||||
7 | policy, except that coverage for evidence-based screenings | ||||||
8 | under this subsection (c) may be subject to a deductible, | ||||||
9 | coinsurance, or other cost-sharing limitation so long as the | ||||||
10 | limitation is not greater than that required for other related | ||||||
11 | cancer risk management benefits covered under the policy. In | ||||||
12 | this subsection, "evidence-based cancer screenings" means | ||||||
13 | medically recommended evidence-based screening modalities in | ||||||
14 | accordance with current clinical practice guidelines.
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15 | Section 30. The Health Maintenance Organization Act is | ||||||
16 | amended by changing Section 5-3 as follows:
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17 | (215 ILCS 125/5-3) (from Ch. 111 1/2, par. 1411.2) | ||||||
18 | Sec. 5-3. Insurance Code provisions. | ||||||
19 | (a) Health Maintenance Organizations shall be subject to | ||||||
20 | the provisions of Sections 133, 134, 136, 137, 139, 140, | ||||||
21 | 141.1, 141.2, 141.3, 143, 143c, 147, 148, 149, 151, 152, 153, | ||||||
22 | 154, 154.5, 154.6, 154.7, 154.8, 155.04, 155.22a, 155.49, | ||||||
23 | 355.2, 355.3, 355b, 355c, 356f, 356g.5-1, 356m, 356q, 356u.10, | ||||||
24 | 356v, 356w, 356x, 356z.2, 356z.3a, 356z.4, 356z.4a, 356z.5, |
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1 | 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, 356z.13, | ||||||
2 | 356z.14, 356z.15, 356z.17, 356z.18, 356z.19, 356z.20, 356z.21, | ||||||
3 | 356z.22, 356z.23, 356z.24, 356z.25, 356z.26, 356z.28, 356z.29, | ||||||
4 | 356z.30, 356z.30a, 356z.31, 356z.32, 356z.33, 356z.34, | ||||||
5 | 356z.35, 356z.36, 356z.37, 356z.38, 356z.39, 356z.40, 356z.41, | ||||||
6 | 356z.44, 356z.45, 356z.46, 356z.47, 356z.48, 356z.49, 356z.50, | ||||||
7 | 356z.51, 356z.53, 356z.54, 356z.55, 356z.56, 356z.57, 356z.58, | ||||||
8 | 356z.59, 356z.60, 356z.61, 356z.62, 356z.64, 356z.65, 356z.67, | ||||||
9 | 356z.68, 364, 364.01, 364.3, 367.2, 367.2-5, 367i, 368a, 368b, | ||||||
10 | 368c, 368d, 368e, 370c, 370c.1, 401, 401.1, 402, 403, 403A, | ||||||
11 | 408, 408.2, 409, 412, 444, and 444.1, paragraph (c) of | ||||||
12 | subsection (2) of Section 367, and Articles IIA, VIII 1/2, | ||||||
13 | XII, XII 1/2, XIII, XIII 1/2, XXV, XXVI, and XXXIIB of the | ||||||
14 | Illinois Insurance Code. | ||||||
15 | (b) For purposes of the Illinois Insurance Code, except | ||||||
16 | for Sections 444 and 444.1 and Articles XIII and XIII 1/2, | ||||||
17 | Health Maintenance Organizations in the following categories | ||||||
18 | are deemed to be "domestic companies": | ||||||
19 | (1) a corporation authorized under the Dental Service | ||||||
20 | Plan Act or the Voluntary Health Services Plans Act; | ||||||
21 | (2) a corporation organized under the laws of this | ||||||
22 | State; or | ||||||
23 | (3) a corporation organized under the laws of another | ||||||
24 | state, 30% or more of the enrollees of which are residents | ||||||
25 | of this State, except a corporation subject to | ||||||
26 | substantially the same requirements in its state of |
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1 | organization as is a "domestic company" under Article VIII | ||||||
2 | 1/2 of the Illinois Insurance Code. | ||||||
3 | (c) In considering the merger, consolidation, or other | ||||||
4 | acquisition of control of a Health Maintenance Organization | ||||||
5 | pursuant to Article VIII 1/2 of the Illinois Insurance Code, | ||||||
6 | (1) the Director shall give primary consideration to | ||||||
7 | the continuation of benefits to enrollees and the | ||||||
8 | financial conditions of the acquired Health Maintenance | ||||||
9 | Organization after the merger, consolidation, or other | ||||||
10 | acquisition of control takes effect; | ||||||
11 | (2)(i) the criteria specified in subsection (1)(b) of | ||||||
12 | Section 131.8 of the Illinois Insurance Code shall not | ||||||
13 | apply and (ii) the Director, in making his determination | ||||||
14 | with respect to the merger, consolidation, or other | ||||||
15 | acquisition of control, need not take into account the | ||||||
16 | effect on competition of the merger, consolidation, or | ||||||
17 | other acquisition of control; | ||||||
18 | (3) the Director shall have the power to require the | ||||||
19 | following information: | ||||||
20 | (A) certification by an independent actuary of the | ||||||
21 | adequacy of the reserves of the Health Maintenance | ||||||
22 | Organization sought to be acquired; | ||||||
23 | (B) pro forma financial statements reflecting the | ||||||
24 | combined balance sheets of the acquiring company and | ||||||
25 | the Health Maintenance Organization sought to be | ||||||
26 | acquired as of the end of the preceding year and as of |
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1 | a date 90 days prior to the acquisition, as well as pro | ||||||
2 | forma financial statements reflecting projected | ||||||
3 | combined operation for a period of 2 years; | ||||||
4 | (C) a pro forma business plan detailing an | ||||||
5 | acquiring party's plans with respect to the operation | ||||||
6 | of the Health Maintenance Organization sought to be | ||||||
7 | acquired for a period of not less than 3 years; and | ||||||
8 | (D) such other information as the Director shall | ||||||
9 | require. | ||||||
10 | (d) The provisions of Article VIII 1/2 of the Illinois | ||||||
11 | Insurance Code and this Section 5-3 shall apply to the sale by | ||||||
12 | any health maintenance organization of greater than 10% of its | ||||||
13 | enrollee population (including , without limitation , the health | ||||||
14 | maintenance organization's right, title, and interest in and | ||||||
15 | to its health care certificates). | ||||||
16 | (e) In considering any management contract or service | ||||||
17 | agreement subject to Section 141.1 of the Illinois Insurance | ||||||
18 | Code, the Director (i) shall, in addition to the criteria | ||||||
19 | specified in Section 141.2 of the Illinois Insurance Code, | ||||||
20 | take into account the effect of the management contract or | ||||||
21 | service agreement on the continuation of benefits to enrollees | ||||||
22 | and the financial condition of the health maintenance | ||||||
23 | organization to be managed or serviced, and (ii) need not take | ||||||
24 | into account the effect of the management contract or service | ||||||
25 | agreement on competition. | ||||||
26 | (f) Except for small employer groups as defined in the |
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1 | Small Employer Rating, Renewability and Portability Health | ||||||
2 | Insurance Act and except for medicare supplement policies as | ||||||
3 | defined in Section 363 of the Illinois Insurance Code, a | ||||||
4 | Health Maintenance Organization may by contract agree with a | ||||||
5 | group or other enrollment unit to effect refunds or charge | ||||||
6 | additional premiums under the following terms and conditions: | ||||||
7 | (i) the amount of, and other terms and conditions with | ||||||
8 | respect to, the refund or additional premium are set forth | ||||||
9 | in the group or enrollment unit contract agreed in advance | ||||||
10 | of the period for which a refund is to be paid or | ||||||
11 | additional premium is to be charged (which period shall | ||||||
12 | not be less than one year); and | ||||||
13 | (ii) the amount of the refund or additional premium | ||||||
14 | shall not exceed 20% of the Health Maintenance | ||||||
15 | Organization's profitable or unprofitable experience with | ||||||
16 | respect to the group or other enrollment unit for the | ||||||
17 | period (and, for purposes of a refund or additional | ||||||
18 | premium, the profitable or unprofitable experience shall | ||||||
19 | be calculated taking into account a pro rata share of the | ||||||
20 | Health Maintenance Organization's administrative and | ||||||
21 | marketing expenses, but shall not include any refund to be | ||||||
22 | made or additional premium to be paid pursuant to this | ||||||
23 | subsection (f)). The Health Maintenance Organization and | ||||||
24 | the group or enrollment unit may agree that the profitable | ||||||
25 | or unprofitable experience may be calculated taking into | ||||||
26 | account the refund period and the immediately preceding 2 |
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1 | plan years. | ||||||
2 | The Health Maintenance Organization shall include a | ||||||
3 | statement in the evidence of coverage issued to each enrollee | ||||||
4 | describing the possibility of a refund or additional premium, | ||||||
5 | and upon request of any group or enrollment unit, provide to | ||||||
6 | the group or enrollment unit a description of the method used | ||||||
7 | to calculate (1) the Health Maintenance Organization's | ||||||
8 | profitable experience with respect to the group or enrollment | ||||||
9 | unit and the resulting refund to the group or enrollment unit | ||||||
10 | or (2) the Health Maintenance Organization's unprofitable | ||||||
11 | experience with respect to the group or enrollment unit and | ||||||
12 | the resulting additional premium to be paid by the group or | ||||||
13 | enrollment unit. | ||||||
14 | In no event shall the Illinois Health Maintenance | ||||||
15 | Organization Guaranty Association be liable to pay any | ||||||
16 | contractual obligation of an insolvent organization to pay any | ||||||
17 | refund authorized under this Section. | ||||||
18 | (g) Rulemaking authority to implement Public Act 95-1045, | ||||||
19 | if any, is conditioned on the rules being adopted in | ||||||
20 | accordance with all provisions of the Illinois Administrative | ||||||
21 | Procedure Act and all rules and procedures of the Joint | ||||||
22 | Committee on Administrative Rules; any purported rule not so | ||||||
23 | adopted, for whatever reason, is unauthorized. | ||||||
24 | (Source: P.A. 102-30, eff. 1-1-22; 102-34, eff. 6-25-21; | ||||||
25 | 102-203, eff. 1-1-22; 102-306, eff. 1-1-22; 102-443, eff. | ||||||
26 | 1-1-22; 102-589, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, |
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| |||||||
1 | eff. 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; | ||||||
2 | 102-804, eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. | ||||||
3 | 1-1-23; 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, | ||||||
4 | eff. 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; | ||||||
5 | 103-91, eff. 1-1-24; 103-123, eff. 1-1-24; 103-154, eff. | ||||||
6 | 6-30-23; 103-420, eff. 1-1-24; 103-426, eff. 8-4-23; 103-445, | ||||||
7 | eff. 1-1-24; 103-551, eff. 8-11-23; revised 8-29-23.)
| ||||||
8 | Section 35. The Voluntary Health Services Plans Act is | ||||||
9 | amended by changing Section 10 as follows:
| ||||||
10 | (215 ILCS 165/10) (from Ch. 32, par. 604) | ||||||
11 | Sec. 10. Application of Insurance Code provisions. Health | ||||||
12 | services plan corporations and all persons interested therein | ||||||
13 | or dealing therewith shall be subject to the provisions of | ||||||
14 | Articles IIA and XII 1/2 and Sections 3.1, 133, 136, 139, 140, | ||||||
15 | 143, 143c, 149, 155.22a, 155.37, 354, 355.2, 355.3, 355b, | ||||||
16 | 356g, 356g.5, 356g.5-1, 356q, 356r, 356t, 356u, 356u.10, 356v, | ||||||
17 | 356w, 356x, 356y, 356z.1, 356z.2, 356z.3a, 356z.4, 356z.4a, | ||||||
18 | 356z.5, 356z.6, 356z.8, 356z.9, 356z.10, 356z.11, 356z.12, | ||||||
19 | 356z.13, 356z.14, 356z.15, 356z.18, 356z.19, 356z.21, 356z.22, | ||||||
20 | 356z.25, 356z.26, 356z.29, 356z.30, 356z.30a, 356z.32, | ||||||
21 | 356z.33, 356z.40, 356z.41, 356z.46, 356z.47, 356z.51, 356z.53, | ||||||
22 | 356z.54, 356z.56, 356z.57, 356z.59, 356z.60, 356z.61, 356z.62, | ||||||
23 | 356z.64, 356z.67, 356z.68, 364.01, 364.3, 367.2, 368a, 401, | ||||||
24 | 401.1, 402, 403, 403A, 408, 408.2, and 412, and paragraphs (7) |
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| |||||||
1 | and (15) of Section 367 of the Illinois Insurance Code. | ||||||
2 | Rulemaking authority to implement Public Act 95-1045, if | ||||||
3 | any, is conditioned on the rules being adopted in accordance | ||||||
4 | with all provisions of the Illinois Administrative Procedure | ||||||
5 | Act and all rules and procedures of the Joint Committee on | ||||||
6 | Administrative Rules; any purported rule not so adopted, for | ||||||
7 | whatever reason, is unauthorized. | ||||||
8 | (Source: P.A. 102-30, eff. 1-1-22; 102-203, eff. 1-1-22; | ||||||
9 | 102-306, eff. 1-1-22; 102-642, eff. 1-1-22; 102-665, eff. | ||||||
10 | 10-8-21; 102-731, eff. 1-1-23; 102-775, eff. 5-13-22; 102-804, | ||||||
11 | eff. 1-1-23; 102-813, eff. 5-13-22; 102-816, eff. 1-1-23; | ||||||
12 | 102-860, eff. 1-1-23; 102-901, eff. 7-1-22; 102-1093, eff. | ||||||
13 | 1-1-23; 102-1117, eff. 1-13-23; 103-84, eff. 1-1-24; 103-91, | ||||||
14 | eff. 1-1-24; 103-420, eff. 1-1-24; 103-445, eff. 1-1-24; | ||||||
15 | 103-551, eff. 8-11-23; revised 8-29-23.)
| ||||||
16 | Section 40. The Illinois Public Aid Code is amended by | ||||||
17 | adding Section 5-52 as follows:
| ||||||
18 | (305 ILCS 5/5-52 new) | ||||||
19 | Sec. 5-52. Genetic testing and evidence-based screenings | ||||||
20 | for an inherited gene mutation. | ||||||
21 | (a) In this Section, "genetic testing for an inherited | ||||||
22 | mutation" means germline multi-gene testing for an inherited | ||||||
23 | mutation associated with an increased risk of cancer in | ||||||
24 | accordance with evidence-based, clinical practice guidelines. |
| |||||||
| |||||||
1 | (b) Subject to federal approval, the medical assistance | ||||||
2 | program, after January 1, 2026, shall provide coverage for | ||||||
3 | clinical genetic testing for an inherited gene mutation for | ||||||
4 | individuals with a personal or family history of cancer, as | ||||||
5 | recommended by a health care professional in accordance with | ||||||
6 | current evidence-based clinical practice guidelines, | ||||||
7 | including, but not limited to, the current version of the | ||||||
8 | National Comprehensive Cancer Network clinical practice | ||||||
9 | guidelines. | ||||||
10 | (c) For individuals with a genetic test that is positive | ||||||
11 | for an inherited mutation associated with an increased risk of | ||||||
12 | cancer, coverage required under this Section shall include any | ||||||
13 | evidence-based screenings, as recommended by a health care | ||||||
14 | professional in accordance with current evidence-based | ||||||
15 | clinical practice guidelines, to the extent that the | ||||||
16 | management recommendation is not already covered by the | ||||||
17 | medical assistance program. In this subsection, | ||||||
18 | "evidence-based cancer screenings" means medically recommended | ||||||
19 | evidence-based screening modalities in accordance with current | ||||||
20 | clinical practice guidelines.
|